Disability determinations for adults with mental disorders: Social Security Administration vs independent judgments.

OBJECTIVES: Disability determinations made by the Disability Determination Service for Social Security Administration (SSA) disability claims due to mental impairment were compared with the independent judgments of a team of mental health workers. The decisions of the Service and the team's agreement with those decisions were predicted from a set of explanatory variables. METHODS: One hundred fifty-eight adult applicants for or beneficiaries of SSA benefit programs participated. The team used SSA disability criteria to judge disability based on in-depth interviews. RESULTS: Team members voted yes, no, or maybe regarding approval for disability. Of the cases approved by the team, 89% were actually allowed by the Disability Determination Service. However, the team could not reach a yes or no decision for almost half of the subjects, contributing to a total agreement with the Service on only 40% of the cases. CONCLUSIONS: Sufficient evidence exists to question the reliability of SSA disability determinations for mental disorders. Although the Disability Determination Service decision for mental impairments can be predicted above chance, a direct test of the reliability of such determinations should be conducted, with particular attention to the effect of the quality of the medical information.

Characteristics of psychiatric discharges from nonfederal, short-term specialty hospitals and general hospitals with and without psychiatric and chemical dependency units: the Hospital Discharge Survey data.

Hospitalization for mental disorders (Major Diagnostic Categories 19 and 20) was examined using the 1980 Hospital Discharge Survey (HDS) data. We added to the HDS data by noting whether each hospital had a specialized psychiatric and/or chemical dependency unit, especially noting short-term specialty psychiatric and chemical dependency hospitals. Of the approximately 1.7 million episodes with MDC-19 and -20 diagnoses in the nation's nonfederal short-term hospitals in 1980, 13.5 percent were in specialty hospitals. Of the remaining general hospital episodes: 31 percent occurred in hospitals with only psychiatric units, 5 percent in hospitals with only chemical dependency units, 31 percent in hospitals with both types of specialized treatment units, and 33 percent in hospitals with neither type of unit. The last figure is much less than previously thought. The five hospital types may be arrayed on a continuum of resource utilization and severity of cases treated, with general hospitals with no special units at one end, specialty hospitals at the other, and general hospitals with psychiatric or chemical dependency units intermediate. Presence or absence of a chemical dependency unit influences a hospital's profile in this regard, particularly for MDC-20. Future studies should take into account the presence of a chemical dependency unit.

Episodic rate of mental hospitalization: stable or increasing?

It is generally accepted that the national rate of mental hospitalization has been stable in recent years (at 1.8 million). That conclusion, based largely on data from the National Institute of Mental Health (NIMH), ignores all inpatient episodes for mental disorders in general hospitals without psychiatric units. Surveying the more extensive data base, the authors previously reported a much larger number of inpatient episodes (about 3 million). This article investigates changes in rates across years and finds a steady increase from 1965 to 1979. The difference is entirely attributable to inpatient episodes in general hospitals without psychiatric units, where the number of episodes has been rapidly increasing.

Proportion of inpatient days for mental disorders: 1969-1978.

Mental hospitalization is an important part of the national picture of hospitalization. Total inpatient days for mental disorders, and their proportion of total hospital days for all disorders, is a statistic of considerable national import, yet there has never been a complete description of total inpatient days for mental disorders. The authors present data from the National Center for Health Statistics for nine years (data for only two years had been published previously), and correct them, and national totals, for the previous exclusion of data from residential treatment centers and community mental health centers. From 1969 through 1978, inpatient days for mental disorders fell from 168 million to 95 million. This decrease was more than accounted for by decreased psychiatric inpatient days at two sites: state mental hospitals and Veterans Administration psychiatric hospitals. The number of psychiatric inpatient days at all other sites increased during this time period. The authors also note a decrease in total inpatient days for all disorders over the decade. However, 85 percent of the total national decrease was accounted for by the decrease in psychiatric inpatient days. The authors stress the implications for public policy and the need for a more adequate national data base.